Trump’s gag rule hurts urban poor women

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Tne urban poor woman is considered better off than her rural counterpart due to her proximity to health services. The reality is that she is still significantly excluded and marginalised.

Experts now say that the “urban advantage” does not exist for the urban poor woman, especially in accessing sexual and reproductive health services.

“Most of us deliver our babies assisted by traditional birth attendants and most of us still trust our friends for advice and we rarely go to the clinics to seek advice,” says Anastasia Wairimu who works at Mirera Flower Farms in Naivasha.

The recent reinstatement of the global gag rule by the Donald Trump administration will have far-reaching implications on the urban poor who still carry the heaviest load when it comes to maternal mortality.

“The rule means any organisation involved in providing sexual and reproductive health services that uses its own money to provide, or even discuss, abortion services will lose any US development funding it receives,” says Evelyn Samba, the Kenya Country Director, Deutsche Stiftung Weltbevoelkerung (DSW).

“That is, even if the activities for which it receives US funding have nothing to do with pregnancy, family planning or abortions,” she adds. The United Nations Population Fund (UNFPA), which provides family planning services in many developing countries including Kenya, is among the first casualties.

The United States has withdrawn its funding to UNFPA. “Access to sexual and reproductive health services, including family planning, helps in cutting maternal and child deaths, eases the burden of post-abortion care as well as new HIV and STI infections,” Samba expounds.

Wairimu knows all too well the dangers of not using family planning. “The woman who helped me deliver my second born told me that I could not get pregnant since I had just given birth, I stopped using family planning,” she says.

Seven months later while going about her duties at the flower farm, she fainted, only to be taken to the clinic and discover that she was three months pregnant. “It was a difficult pregnancy.

I ended up having a miscarriage and I have been anaemic ever since,” says the 28-year-old Wairimu. Her story is not unique. In fact hers would be considered to have had a happy ending bearing in mind that though at the national level government statistics show that about 362 women die in every 100,000 live births. Among the urban poor, the numbers are higher at over 700 deaths in every 100,000 live births.

“The urban poor woman will most likely deliver at home and be assisted by a traditional birth attendant. When complications arise, there is no way to get this woman to the hospital fast enough, especially because of lack of infrastructure in the slums,” says Dr Gikama Kinyanjui, a gynaecologist and obstetrician in Naivasha.

He says though these women will have attended at least one antenatal clinic visit, nearly half of them will not make it to the recommended four visits.

“This is why the government must focus on raising domestic funding to ensure family planning methods are available for the urban poor woman to avoid unplanned pregnancies,” Dr Gikama expounds.

Samba explains that in the light of dwindling external resources, “county governments need to increase investment in sexual and reproductive health service provision, especially family planning services.”

It is against this backdrop that the County government of Nakuru recently launched guidelines to particularly bring maternal health services closer to its people.

This has been done through the launch of the County Family Planning Costed Implementation Plan 2017-2021. Both national and county governments have expressed commitments to address the main challenges that affect the quality of sexual and reproductive health services that the urban poor woman receives.

This is being done by assessing the demand side and making efforts to remove obstacles that hinder these women from going to health facilities for services in the first place.

There are also initiatives that are working to improve the supply side. “This is where we improve the infrastructure around the health system,” says Dr Kinyanjui.

Other efforts include elimination of the urban exclusion whereby the urban poor have remained marginalised and vulnerable unable to access quality services.

“Continued access to sexual and reproductive health services will likely translate into a healthier, more economically productive population to power Kenya’s development aspirations,” Samba says.

Domestic mobilisation of resources will further ensure successes witnessed particularly in maternal health over the last decade do not go down the drain.

Maternal deaths have dropped from 488 in every 100,000 live births in 2008/09 to the current 362. Deliveries attended by skilled attendant have risen from 43 per cent in 2008/09 to 62 per cent. Within the same period pregnant women who received any antenatal care rose from 92 per cent to 96 per cent.